Barriers to receiving testosterone replacement therapy in the community during COVID-19 pandemic

Abstract

Background: While the etiology for the upsurge in testosterone testing and prescriptions is likely multifactorial, increased direct-to-consumer marketing and the expansion of clinical care centers devoted to testosterone treatment likely play a role. Many of these centers require patients to report, in-person, on a regular basis for their injectable therapy and/or lab studies. The purpose of our study was to investigate barriers of care that patients receiving treatment for testosterone deficiency may be experiencing in the setting of COVID-19.

Methods: Our survey was posted on a closed Facebook support page for males currently receiving testosterone treatment and members of the group were invited to participate. The survey asked participants several questions related to how they received their injections, if they've experienced difficulties obtaining their injections due to COVID-19 restrictions, and about their interest in telemedicine services for their care.

Results: The majority of patients were able to receive their treatment despite barriers enforced by the pandemic. Of the 104 participants, almost half received their testosterone prescriptions from an outpatient clinic dedicated to testosterone replacement, while the other half received their therapy from a PCP, endocrinologist, or urologist. Only 5 patients (4.8%) noted difficulties obtaining their injections during this pandemic, 4 of which received their prescriptions from dedicated testosterone clinics, and the other from a PCP. Nearly 90% of respondents self-administered their testosterone therapy. With regards to telemedicine, 57.8% of patients have utilized the technology in some capacity, however 74.4% said that they would prefer to use telemedicine video services with a urologist or APP with expertise in andrology over in-person services.

Conclusions: In our survey, the majority of the respondents have been able to receive their injectable testosterone therapy despite the ongoing pandemic. The majority of respondents self-administer their treatments, which may explain the lack of barriers. This study is the first of its kind to investigate the effect of a pandemic on the receipt of care for those being treated for testosterone deficiency with injectable testosterone.

Keywords: COVID; Testosterone replacement; barriers; testosterone replacement therapy (TRT).